Coordinate instrument set

ABSTRACT

Surgical instruments for use in mapping tissue defects include telescoping rulers and tubes. One of the instruments has a pointed anchoring tip for piercing tissue near the site of the defect. Another instrument has a hook for catching an anatomical landmark. Measuring portions of the rulers of both instruments include distance indicia so that a coordinate system can be established for mapping the location of the defect or of an implant at the defect site. The coordinate system can be re-established at a later time using the same fixation point for the anchoring tip and the same landmark for the hook to evaluate the clinical effects of the treatment selected. The method of using the instrument set is also described.

This application claims the benefit of U.S. Provisional Application No.60/623,624 filed on Oct. 29, 2004, by Anthony D. Zannis, Herbert E.Schwartz, Prasanna Malaviya, Keith M. McGrath, Danny E. McAdams, AndrewM. Jacobs, Jack Farr, II and Randall L. Holcomb entitled “CoordinateInstrument Set,” which is incorporated by reference herein in itsentirety.

FIELD OF THE INVENTION

The present invention relates to surgical instruments and moreparticularly to surgical instrument sets that can be used to measure andmap defects and to monitor the effects of a treatment regime over time.

BACKGROUND OF THE INVENTION

Various types of Minimally Invasive Surgery (“MIS”) are being performedby surgeons, including laparoscopy, endoscopy and arthroscopy surgery.In arthroscopy, small incisions are made at the affected joint to formportals for the insertion of instruments, including a small lens andlighting system (an arthroscope). The arthroscope is connected to aviewing device, such as a television camera to allow the surgeon to seethe interior of the joint. Other instruments are inserted through otherportals to perform a variety of tasks. For example, the surgicalinstrument may include an implement for manipulating native tissue (forexample, tissue grasping, tissue cutting, bone abrading), or animplement for introducing and implanting a therapeutic device.

Typical surgical instruments used in arthroscopic procedures includerongeurs, such as the Kerrison rongeur, punch forceps, basket forceps,suction punches and cup curette, for example. Examples of arthroscopicinstruments are described and illustrated in O'Connor's Textbook ofArthroscopic Surgery, 2^(nd) ed., 1992, Chapter 19.

In many surgical settings, it is often necessary for the surgeon to makemeasurements between two points. Due to the confined spaces ofarthroscopic surgery, measuring such distances is often quite difficult,particularly when the measurement needed is larger than the size of theincision or transverse to the direction of the incision. Arthroscopicknee surgery provides many such situations. For example, it may behelpful if a surgeon could measure the size of a defect in the meniscusof a knee, to aid in choosing the appropriate method to repair thedefect.

An arthroscopic measuring device is disclosed in U.S. Pat. No.6,427,351B1, which is incorporated by reference herein in its entirety.The device disclosed in that patent provides a handle and an extension.The extension has a distal tip for intraoperative insertion into thebody through an incision. Two wires extend from a block in the handlethrough passageways in two separate tubes that comprise the extension.The block is connected to an actuator element. The actuator elementsdisclosed can be moved back and forth in a direction parallel to thelongitudinal axis of the handle to move the wires out of an into thetubes. At their distal ends, the tubes diverge at a fixed angle so thatthe distance between the ends of the wires increases as the wires arepushed further outward and decreases as the wires are pulled back intothe handle. Calibrations on the handle correspond with the distancebetween the ends of the wires so that the surgeon can determine one ormore of the dimensions of a defect in the bone or cartilage.

Although the arthroscopic measuring device disclosed in U.S. Pat. No.6,427,351B1 provides a useful surgical tool, operation of the actuatingmechanism disclosed can be difficult for the surgeon, particularly dueto friction as the wires are pushed through the divergent tube endings.In addition, use of that device may require that the surgeon use bothhands to hold the handle and move the actuating mechanism. Finally, useof that device may not allow for repeatable measurements of the tissueand changes in the tissue over time.

Determining the size and location of a defect at a tissue site, such asthe meniscus of the knee joint, can be useful in several arthroscopicprocedures.

Common surgical procedures for treating meniscal damage include tearrepairs and meniscectomies. A tear repair is most commonly performedwhen the tear is a clean longitudinal vertical lesion in the vascularred zone of the meniscus. The basic strategy is to stabilize the tear bylimiting or eliminating radial separation of the faces of the tear whenthe meniscus is load bearing. Many devices and surgical procedures existfor repairing meniscal tears by approximating the faces of the meniscusat the tear. Examples of such devices and procedures are disclosed inthe following U.S. Pat. Nos.: 6,319,271; 6,306,159; 6,306,156;6,293,961; 6,156,044; 6,152,935; 6,056,778; 5,993,475; 5,980,524;5,702,462; 5,569,252; 5,374,268; 5,320,633; and 4,873,976.

Meniscectomies involve the surgical removal of part of the meniscus.Such procedures have generally been performed in cases of radial tears,horizontal tears, vertical longitudinal tears outside the vascular zone,complex tears, or defibrillation. Although meniscectomies provideimmediate relief to the patient, in the long term the absence of part ofthe meniscus can cause cartilage wear on the condylar surface,eventually leading to arthritic conditions in the joint.

A variety of orthopaedic implants are available for treating damagedsoft tissue. Orthopaedic implants for treatment of damaged menisci aredisclosed in the following U.S. Pat. Nos.: 6,042,610; 5,735,903;5,681,353; 5,306,311; 5,108,438; 5,007,934; and 4,880,429.

In tear repairs, meniscectomies, and in treatments involving the use ofimplants, there exists a need for instruments that not only allow formeasurement of the sizes of the defects, but also for mapping the defectin a repeatable manner so that the clinical results of the treatment canbe monitored over time.

SUMMARY OF THE INVENTION

The present invention provides an instrument set and a surgicaltechnique for mapping the location of a tissue defect, or the locationof an implant, over time, and for measuring the defectintra-operatively.

In one aspect, the present invention provides a surgical instrumenthaving a proximal end and a distal end. The surgical instrumentcomprises a tube and a ruler. The tube has a proximal end, a distal end,and an elongate channel, The ruler has a proximal end, a distal end, astraight portion received within the channel of the tube, a measurementportion between the straight portion and the distal end and an anchoringtip at the distal end. The measurement portion of the ruler includesdistance indicia. The anchoring tip has a pointed end. The measurementportion of the ruler lies in a plane. The pointed-end of the anchoringtip is spaced from the plane of the measurement portion of the ruler.The ruler is reciprocable in a proximal-distal direction with respect tothe tube between a retracted position and an extended position.

In another aspect, the present invention provides a surgical instrumenthaving a proximal end and a distal end. The surgical instrumentcomprises a tube and a ruler. The tube has a proximal end, a distal end,and an elongate channel. The ruler has a proximal end, a distal end, astraight portion received within the channel of the tube, a measurementportion between the straight portion and the distal end and a hook atthe distal end. The measurement portion of the ruler includes distanceindicia. The ruler is reciprocable in a proximal-distal direction withrespect to the tube between a retracted position and an extendedposition.

In another aspect, the present invention provides a surgical instrumentset comprising first and second surgical instruments. Each surgicalinstrument has a proximal end and a distal end, and each surgicalinstrument comprises a tube and a ruler. The tube of each surgicalinstrument has a proximal end, a distal end and a channel extending fromthe proximal to the distal end. The ruler of each surgical instrumenthas a proximal end, a distal end, a measurement portion between theproximal end and the distal end and a straight portion between themeasurement portion and the proximal end. The measurement portionincludes distance indicia. The straight portion of the ruler of eachsurgical instrument has a longitudinal axis. The ruler of each surgicalinstrument is reciprocable in a proximal-distal direction with respectto the tube between a retracted position and an extended position. Thedistal end of the ruler of the first surgical instrument comprises ananchoring tip. The anchoring tip has a pointed end. The distal end ofthe ruler of the second surgical instrument comprises a hook.

In another aspect, the present invention provides a surgical instrumentset comprising a plurality of surgical instruments. Each surgicalinstrument has a proximal end and a distal end, and each surgicalinstrument comprises a tube and a ruler. The tube of each surgicalinstrument has a proximal end, a distal end and a channel extending fromthe proximal to the distal end. The ruler of each surgical instrumenthas a proximal end, a distal end, a measurement portion between theproximal end and the distal end and a straight portion between themeasurement portion and the proximal end. The measurement portionincludes distance indicia. The straight portion of the ruler of eachsurgical instrument has a longitudinal axis. The ruler of each surgicalinstrument is reciprocable in a proximal-distal direction with respectto the tube between a retracted position and an extended position. Themeasurement portion of the ruler of each surgical instrument extends ina different direction from the longitudinal axis of the straight portionwhen the ruler is in the extended position.

In another aspect, the present invention provides a method of mapping afeature of a tissue site of a patient with a surgical instrument. Thesurgical instrument includes a tube and a ruler reciprocable withrespect to the tube between a retracted position and an extendedposition. The ruler includes a distal end and distance indicia. Themethod comprises moving a portion of the tube to the tissue site with atleast part of the ruler retracted. The tissue is pierced with a portionof the ruler at a selected fixation point to temporarily anchor thedistal end of the ruler to the tissue at the fixation point. The tube ismoved with respect to the ruler so that the ruler is in the extendedposition. A distance is determined based on the position of the tissuefeature with respect to the fixation site. The tube is moved withrespect to the ruler so that the ruler is in the retracted position andthe tube and ruler are removed from the tissue site.

In another aspect, the present invention comprises a method of measuringa feature of a tissue site within the body of a patient with a surgicalinstrument. The surgical instrument includes a tube having a proximalend and a distal end. An elongated member is reciprocable with respectto the tube between a distally retracted position and a distallyextended position. The elongated member has a proximal end and a distalend, and distance indicia at its proximal end. The method comprisesmoving the distal end of the tube to the tissue site within the body ofthe patient and positioning the distal end of the elongated member at afirst desired location. The tube is moved with respect to the elongatedmember so that the distal end of the tube is at a second desiredlocation while the position of the distal end of the elongated member ismaintained at the first desired location. The distance between the firstdesired location and the second desired location is determined byobserving the distance indicia at the proximal end of the elongatedmember.

In another aspect, the present invention comprises a method of mapping afeature of a tissue site of a patient with a surgical coordinateinstrument and a surgical measuring instrument. The surgical coordinateinstrument includes a tube and a coordinate ruler reciprocable withrespect to the tube between a retracted position and an extendedposition. The coordinate ruler includes a distal end and distanceindicia. The surgical measuring instrument includes a tube and a rulerreciprocable with respect to the tube between a retracted position andan extended position. The ruler includes a distal end and distanceindicia. The method comprises moving a portion of the tube of thecoordinate instrument to the tissue site with at least part of thecoordinate ruler retracted. The tissue is pierced with a portion of thecoordinate ruler at a selected fixation point to temporarily anchor thedistal end of the coordinate ruler to the tissue at the fixation point.The tube is moved with respect to the coordinate ruler so that thecoordinate ruler is in the extended position. A portion of the tube ofthe measuring instrument is moved to the tissue site with at least partof the ruler retracted. The distal end of the ruler is placed at adesired location related to the tissue feature to be mapped. The tube ismoved with respect to the ruler until a portion of the measuringinstrument crosses the coordinate ruler. The distance between the distalend of the ruler and the coordinate ruler is then determined.

In another aspect the present invention comprises a surgical instrumenthaving a proximal end and a distal end. The instrument comprises ahandle, a tube and an elongated member. The tube extends distally fromthe handle, and defines a channel. A first gear is rotatably mounted tothe handle, and has a plurality of grooved teeth. A second gear isrotatably mounted to the handle, and has a plurality of grooved teethintermeshed with the grooved teeth of the first gear. The grooves of theintermeshed teeth of the first gear and second gear define a passagewayaligned with the channel of the tube. The elongated member extendsthrough the passageway and into the channel of the tube. The elongatedmember is movable in a proximal direction by rotating the first gear inone direction and is movable in the distal direction by rotating thefirst gear in the opposite direction. The elongated member has a distalend and includes distance indicia at the distal end.

Additional features of the present invention will become apparent tothose skilled in the art upon consideration of the following detaileddescription of preferred embodiments exemplifying the best mode ofcarrying out the invention as presently perceived.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a top plan view of a set of surgical instruments with rulersin an extended position;

FIG. 2 is a representative longitudinal cross-section of arepresentative handle assembly of the instruments of FIG. 1, taken alongline 2-2 of FIG. 1;

FIG. 3 is a perspective view of a representative ruler assembly of oneof the intra-articular measurement instruments of FIG. 1;

FIG. 4A is an enlarged side elevation of the hook at the distal end ofthe ruler of FIG. 3;

FIG. 4B is an enlarged bottom plan view of the hook of FIG. 4A;

FIG. 4C is an enlarged side elevation of the anchoring tip at the distalend of the ruler of the intra-articular coordinate surgical instrumentof FIG. 1;

FIG. 5 is a top plan view of the proximal portion of the actuator shaftportion of a representative ruler assembly, shown with the actuator knobremoved and with the actuator shaft received within the proximal portionof the tube of the surgical instrument, the tube being shown inlongitudinal cross-section;

FIG. 6 is a top plan view of the distal portion of the actuator shaft ofFIG. 5, illustrating the connection between the distal end of theactuator shaft and the proximal end of the ruler, with the tube beingshown in longitudinal cross-section;

FIG. 7 is a top plan view of a representative proximal portion of theruler adjacent to the portion illustrated in FIG. 6, with the tube beingshown in longitudinal cross-section;

FIG. 8 is a top plan view of the distal measuring portion of the rulerwire of one of the intra-articular measurement instruments of theinstrument set of FIG. 1, with the tube being shown in longitudinalcross-section;

FIG. 9 is a top plan view of the distal measuring portion of the rulerof one of the intra-articular coordinate instruments of the instrumentset of FIG. 1, with the tube being shown in longitudinal cross-section;

FIG. 10 is a top plan view of the distal measuring portion of the rulerof the second intra-articular coordinate instruments of the instrumentset of FIG. 1, with the tube being shown in longitudinal cross-section;

FIG. 11 is a top plan view of the distal measuring portion of the rulerof another of the intra-articular measurement instruments of theinstrument set of FIG. 1, with the tube being shown in longitudinalcross-section;

FIG. 12 is a top plan view of the distal measuring portion of the rulerof another of the intra-articular measurement instruments of theinstrument set of FIG. 1, with the tube being shown in longitudinalcross-section;

FIG. 13 is a top plan view of an alternative distal measuring portion ofa ruler, with the tube being shown in longitudinal cross-section;

FIG. 14 is a top plan view of one of the intra-articular coordinateinstruments of the set of FIG. 1, shown with the ruler in a fullyretracted position;

FIG. 15 is a view similar to FIG. 14, shown with the ruler in a firstintermediate extended position;

FIG. 16 is a view similar to FIGS. 14-15, shown with the ruler in asecond intermediate extended position;

FIG. 17 is a view similar to FIGS. 14-16, shown with the ruler in afully extended position;

FIG. 18 is a top plan view of one of the intra-articular measurementinstruments of the set of FIG. 1, shown with the ruler in a fullyretracted position;

FIG. 19 is a view similar to FIG. 18, shown with the ruler in a firstintermediate extended position;

FIG. 20 is a view similar to FIGS. 18-19, shown with the ruler in asecond intermediate extended position;

FIG. 21 is a view similar to FIGS. 18-20, shown with the ruler in afully extended position;

FIG. 22 is a top plan view of another of the intra-articular measurementinstruments of the set of FIG. 1, shown with the ruler in a fullyretracted position;

FIG. 23 is a view similar to FIG. 22, shown with the ruler in a firstintermediate extended position;

FIG. 24 is a view similar to FIGS. 22-23, shown with the ruler in asecond intermediate extended position;

FIG. 25 is a view similar to FIGS. 23-24, shown with the ruler in afully extended position;

FIG. 26 is a top plan view of another of the intra-articular measurementinstruments of the set of FIG. 1, shown with the ruler in a fullyretracted position;

FIG. 27 is a view similar to FIG. 26, shown with the ruler in a firstintermediate extended position;

FIG. 28 is a view similar to FIGS. 26-27, shown with the ruler in asecond intermediate extended position;

FIG. 29 is a view similar to FIGS. 26-28, shown with the ruler in afully extended position;

FIG. 30 is a diagrammatic perspective view of a meniscus shown with oneof the intra-articular coordinate instruments of the set of FIG. 1anchored at a fixation point;

FIG. 31 is a view similar to FIG. 30, shown with the intra-articularcoordinate instruments of the set of FIG. 1 anchored at a fixation pointand one of the intra-articular measuring instruments of the set of FIG.1 crossing the intra-articular coordinate instrument;

FIG. 32 is a diagrammatic perspective view of a meniscus shown with oneof the intra-articular coordinate instruments of the set of FIG. 1anchored at an alternative fixation point;

FIG. 33 is a view similar to FIG. 32, shown with the intra-articularcoordinate instruments of the set of FIG. 1 anchored at the alternativefixation point of FIG. 32 and one of the intra-articular measuringinstruments of the set of FIG. 1 crossing the intra-articular coordinateinstrument;

FIG. 34 is a diagrammatic representation of a meniscus with one of theintra-articular measuring instruments of the set of FIG. 1 shown withoutany intra-articular coordinate instrument;

FIG. 35 is a diagrammatic representation of a meniscus with one of theintra-articular measuring instruments of the set of FIG. 1 shown withoutany intra-articular coordinate instrument;

FIG. 36 is a top plan view of the distal portion of the actuator used inthe measurements illustrated in FIGS. 34 or 35;

FIG. 37 is a top plan view of an alternative handle assembly that may beused for any of the instruments illustrated in FIGS. 1 and 14-29;

FIG. 38 is a cross-section of the handle assembly of FIG. 37 taken alongline 38-38 of FIG. 37;

FIG. 39 is a cross-section of the handle assembly of FIG. 37 taken alongline 39-39 of FIG. 37; and

FIG. 40 is an enlarged view of the cross-section of FIG. 39.

DETAILED DESCRIPTION

Surgical instruments embodying the principles of the present inventionare illustrated in the accompanying drawings. FIG. 1 illustrates asurgical instrument set 10 comprising a plurality of individualintra-articular instruments 12A, 12B, 12C, 12D, and 12E that can be usedto measure and map a tissue defect, such as a meniscal defect. Anotherintra-articular instrument that may be included in such a set isillustrated in FIGS. 22-25 at 12F. As used herein, “defect” is intendedto include both tissue tears and gaps in tissue left after part of thetissue has been removed, such as through a meniscectomy. As used herein,“intra-articular instruments” refers to instruments with portions thatcan be received within an intra-articular space, such as the knee jointspace, without significant distraction of the bones forming the joint.Although the instrument set 10 of FIG. 1 includes five individualinstruments, it should be understood that the principles of the presentinvention are applicable to instrument sets having fewer or more thanfive instruments, as well as to individual instruments; the presentinvention should not be considered to be limited to any particularnumber of instruments unless expressly called for in the claims.

As shown in FIGS. 1 and 14-29, each of the illustrated instruments 12A,12B, 12C, 12D, 12E, 12F has a proximal end 11A, 11B, 11C, 11D, 11E, 11Fand a distal end 13A, 13B, 13C, 13D, 13E, 13F. As used herein,“proximal” refers to the end or portion nearer to the surgeon, and“distal” refers to the end or portion further from the surgeon.

In the instrument set 10 illustrated in FIG. 1, two of the instruments12A and 12C comprise intra-articular coordinate instruments and theremaining instruments 12B, 12D, 12E comprise intra-articular measuringinstruments. Instrument 12F also comprises an intra-articular measuringinstrument. As described in more detail below, the intra-articularcoordinate instruments 12A, 12C have features that allow the distal endsto be fixed to a selected anatomical site repeatedly over time, such asduring surgery and post-operatively for clinical evaluation of theeffectiveness of the procedure used. The intra-articular coordinateinstruments 12A, 12C allow the surgeon to define a reference, baselineor benchmark that can be re-established periodically; the additionalintra-articular measuring instruments 12B, 12D, 12E of the set (as wellas intra-articular measuring instrument 12F) allow the surgeon toperiodically establish a second reference that can be re-establishedperiodically with respect to the position of the intra-articularcoordinate instrument 12A, 12C and another anatomical reference. Twointra-articular coordinate instruments 12A, 12C are provided so that theinstrument set can be used for both the medial and lateral horns of themeniscus. It should be understood that the illustrated instrument set isdesigned for use in treating and evaluating the meniscus; variations maybe made in the illustrated instrument set for application to use atother tissue sites in the patient's body.

As shown in FIGS. 1 and 14-29, each illustrated instrument 12A, 12B,12C, 12D, 12E, 12F includes a tube 14A, 14B, 14C, 14D, 14E, 14F and aruler 16A, 16B, 16C, 16D, 16E, 16F. Each tube 14A, 14B, 14C, 14D, 14E,14F has a distal end 18A, 18B, 18C, 18D, 18E, 18F and a proximal end. Arepresentative proximal end of a representative tube is illustrated inFIG. 2 at 20. Each ruler 16A, 16B, 16C, 16D, 16E, 16F also has a distalend 22A, 22B, 22C, 22D, 22E, 22F and a proximal end. A representativeproximal end 24B of a representative ruler 16B is illustrated in FIG. 3.

As shown in FIGS. 1 and 14-29, each illustrated instrument 12A, 12B,12C, 12D, 12E, 12F includes a handle assembly 26A, 26B, 26C, 26D, 26E,26F. A representative handle assembly is shown in longitudinalcross-section in FIG. 2. The description of the handle assembly of FIG.2 is applicable to all of the handle assemblies 26A, 26B, 26C, 26D, 26E,26F shown in FIGS. 1, 2 and 14-29. An alternative handle assembly isillustrated in FIGS. 35-38 and described below.

Each handle assembly 26A, 26B, 26C, 26D, 26E, 26F includes a main body28A, 28B, 28C, 28D, 28E, 28F, a tapered front piece 30A, 30B, 30C, 30D,30E, 30F a ferrule 32A (shown in FIG. 2) and a ball plunger 34A, 34B,34C, 34D, 34E, 34F. The tapered front piece 30A, 30B, 30C, 30D, 30E, 30Fincludes a threaded female portion that is threaded onto a threaded maleportion of the main body 28A, 28B, 28C, 28D, 28E, 28F capturing theferrule 32A between the main body and the tapered front piece.

In FIG. 2, and in the following description of the handle assemblies,reference numbers are used without letter designations to indicate thatthe illustration and description applies to the handle assemblies of allthe instruments 12A, 12B, 12C, 12D, 12E and 12F illustrated in FIGS. 1,2 and 14-29. The portions of the instrument illustrated in FIGS. 5-7 arealso common to all of the instruments 12A, 12B, 12C, 12D, 12E and 12Fillustrated in FIGS. 1-2 and 14-29; reference numbers have also beenused without letter designations in FIGS. 5-7 and in the followingdescription to indicate that the illustrations and description appliesto all of the instruments 12A, 12B, 12C, 12D, 12E, 12F.

As shown in FIG. 2, the main body 28 and tapered front piece 30 of thehandle assembly have elongate central channels 36, 37 that receive astraight portion of the tube 14. As shown in FIG. 2, the tube 14 islocked in position on the handle assembly by the ball plunger 34engaging a recess 35 in the tube 14. Also as shown in FIG. 2, the tube14 has an elongate channel 38 that is co-axial with the elongatechannels 36, 37 of the main body 28 and front piece 30.

The tube 14 receives a portion of an actuator shaft 40 in the channel38. The proximal end of the actuator shaft 40 is threaded (as shown at41 in FIG. 5) and is received in and connected to a threaded femaleopening in an actuator handle 42.

The actuator shaft 40 is reciprocable with respect to the channel 38 ofthe tube 14. The surgeon can move the actuator shaft 40 in theproximal-distal direction with respect to the channel by pushing andpulling on the actuator handle 42 or by holding the actuator handle 42steady while moving the handle assembly 26 in a proximal-distaldirection.

The distal end of each actuator shaft 40 has an axial female openingsized and shaped to receive the proximal end of one ruler 16 and isconnected to the proximal end 24 of each ruler 16. To connect each shaft40 to each ruler 16, any mechanical means could be used, such as a setscrew, for example; alternatively or in addition, adhesive could beused, for example. The illustrated actuator shaft 40 may have an overalllength of about 5.5 inches, for example, and a diameter of about 0.09inches, for example.

A representative ruler assembly is illustrated in FIG. 3. Each rulerassembly comprises an actuator shaft 40A, 40B, 40C, 40D, 40E, a ruler16A, 16B, 16C, 16D, 16E and an actuator handle 42A, 42B, 42C, 42D, 42E.

FIGS. 5 and 6 illustrate an exemplary actuator shaft 40 with a proximalportion 44 (shown in FIG. 5) and an integral co-axial distal portion 46(shown in FIG. 6). The tube 14 is illustrated in cross-section. As shownin FIG. 5, the proximal portion 44 of the actuator shaft may includedistance indicia, shown at 48. The distance indicia may comprise aplurality of spaced transverse markings and numerical references toindicate distance. In FIG. 6, a representative ruler is shown at 16connected to the distal end of the actuator shaft.

Portions of a representative ruler 16 are illustrated in FIG. 7extending longitudinally through the tube 14. The portions of therepresentative ruler 16 include a straight portion 50 within the tube14.

The distal ends of the tubes and rulers are different for each of theillustrated instruments 12A, 12B, 12C, 12D, 12E, 12F. FIG. 8 illustratesthe distal ends 18B, 22B of the tube 14B and ruler 16B of the straightmeasuring instrument 12B. FIG. 9 illustrates the distal ends 18A, 22A ofthe tube 14A and ruler 16A of one of the coordinate instruments 12A witha curved distal portion and FIG. 10 illustrates the distal ends 18C, 22Cof the tube 14C and ruler 16C of the other coordinate instrument 12Cwith a curved distal portion (the distal portion of the ruler 16C beingcurved in the opposite direction of the distal portion of the ruler 16Aof coordinate instrument 12A). FIG. 11 illustrates the distal ends 18D,22D of the tube 14D and ruler 16D of the measuring instrument 12D. FIG.12 illustrates the distal ends 18E, 22E of the tube 14E and ruler 16E ofthe measuring instrument 12E. Another alternative configuration for ameasuring instrument is shown in FIG. 13, where analogous parts areindicated by a like reference number followed by the letter designationF.

Each of the illustrated tubes 14A, 14B, 14C, 14D, 14E, 14F has an outerdiameter of 0.120 inches and an inner diameter of 0.09 inches. Tubes ofsuch diameters should be capable of being used in arthroscopic surgery,and should fit within the intra-articular space in the human knee. Foruse in arthroscopic surgery, it is preferred that the outer diameter ofthe tubes not exceed 0.47 inches (12 mm). The illustrated straight tubes14B, 14D have overall lengths of 8.6 inches. Tubes 14A, 14C, 14F havestraight portions having lengths of 8.12 inches and portions angled at45° having lengths of 0.25 inches joined by curved portions having aradius of curvature of 0.25 inches. Tube 14E has a straight portion witha length of 7.74 inches and a curved end portion having a radius ofcurvature of 0.50 inches over an arc of 90°. It should be understoodthat these dimensions are provided as examples only; the presentinvention is not limited to any particular dimension or use unlessexpressly called for in the claims.

In each of the illustrated embodiments, the ruler 16A, 16B, 16C, 16D,16E, 16F includes a measurement portion 52A, 52B, 52C, 52D, 52E, 52Fthat is integral with the straight portion 50. The integral measurementportions 52A, 52B, 52C, 52D, 52E, 52F include distance indicia 54A, 54B,54C, 54D, 54E, 54F, comprising spaced transverse markings in theillustrated embodiments.

The illustrated rulers 16A, 16B, 16C, 16D, 16E, 16F comprise wireshaving diameters on the order of 0.0190-0.0195 inches and overalllengths of about 5.5 inches to 6.1 inches. It should be understood thatthese dimensions are provided as examples only; the present invention isnot limited to any particular dimension unless expressly called for inthe claims.

Referring now to the measuring instrument 12B, as shown in FIGS. 8 and18-21, the entire tube 14B is straight from the proximal end 20B to thedistal end 18B, and the measurement portion 52B of the ruler 16B isstraight and co-axial with the straight portion 50 of the ruler 16B. Thedistal end 22B of the ruler 16B comprises a hook 56B. The hook 56Bcomprises a segment that curves or angles away from the straightportion, defining an angle of about 90° with the longitudinal axis 57(shown in FIGS. 4A, 4B and FIG. 7) of the straight portion 50 whileremaining co-planar therewith. As used herein, “hook” is intended toinclude any curved, angled or bent end portion that is sized and shapedso that it can be used to temporarily catch and hold onto tissue, and sothat it can be easily removed by the surgeon. Preferably, the curved,angled or bent end has sufficient surface area so that it does not diginto the tissue, and the distal end is preferably blunt so that the enddoes not dig into tissue. FIG. 4B illustrates an example of a hook witha rounded distal end 22B.

The range of movement of the measuring instrument 12B is illustrated inFIGS. 18-21. FIG. 18 shows the measuring instrument 12B with theactuator shaft 40B fully retracted, thereby retracting the measurementportion 52B fully into the channel 38 of the tube 14B. The ruler mayalso be retracted until the hook 56B at the distal end 22B is pulledfully into the channel 38 of the tube 14B. The actuator knob or handle42B may also be pushed or slid in the distal direction (or held steadywhile the handle assembly 26B is moved in the proximal direction) toextend the ruler to intermediate positions, such as those shown in FIGS.19 and 20, and to a fully extended position, shown in FIG. 21.

Referring now to the coordinate instruments 12A and 12C, as shown inFIGS. 9-10 and 14-17, the distal portions of the illustrated tubes 14A,14C are angled away from the straight portion at an angle of about 135°.In the coordinate instrument 12A of FIG. 9, the distal portion of thetube is angled to the right while in the coordinate instrument 12C ofFIG. 10, the distal portion of the tube is angled to the left. As shownin FIGS. 9-10, the measurement portions 52A, 52C of these coordinateinstruments 12A, 12C include portions that are curved; in the coordinateinstrument 12A of FIG. 9, the measurement portion 52A curves to theright while in the coordinate instrument 12C of FIG. 10, the measurementportion 52C curves to the left. Each of the illustrated curved portionsof the measurement portions has a radius of curvature of 0.880 inchesand a 90° arc. The curvature in the illustrated coordinate instruments12A and 12C is provided for use of the coordinate instruments inmeasuring and mapping portions of the meniscus, and the curvaturerelates to the standard curvature of the meniscus. It should beunderstood that the curvature can be varied, and that the shape of themeasurement portion of the two coordinate instruments 12A, 12C can bevaried for other anatomical sites. For example, the measurement portions52A, 52C of the coordinate rulers 16A, 16C could be straight instead ofcurved. In addition, the tubes 14 could be straight along their entirelengths if desired with straight, angled or curved measurement portionsof coordinate rulers.

The distal ends 22A, 22C of the coordinate instruments 12A, 12C of FIGS.9-10 comprise anchoring tips 58A, 58C. A representative anchoring tip isillustrated in FIG. 4C; it should be understood that the followingdescription applies to both anchoring tips.

As shown in FIG. 4C, the anchoring tip 58A includes a pointed end 60Athat is spaced from the plane 62 of the straight portion 50 andmeasurement portion 52A of the ruler 16A. The pointed end 60A of theanchoring tip 58 is at the end of a straight segment 64A and may berazor sharp to facilitate anchoring the tip in the patient's tissue, asdescribed below. The straight segment 64A of the anchoring tip 58A has alongitudinal axis 66A that is perpendicular to the plane 62 in theillustrated embodiment. The anchoring tip 58C of the coordinateinstrument 12C of FIG. 10 has the same structure as that described aboveand illustrated in FIG. 4C.

FIGS. 14-17 illustrate the range of motion for the coordinate instrument12C. FIG. 14 shows the coordinate instrument 12C with the actuator shaft40C fully retracted, thereby retracting the measurement portion 52Cfully into the channel 38 of the tube 14C. The ruler may also beretracted until the anchoring tip 58C at the distal end 22C is pulledfully into the channel 38 of the tube 14C. The actuator knob or handle42C may also be pushed or slid in the distal direction (or held steadywhile the handle assembly 26C is moved in the proximal direction) toextend the ruler to intermediate positions, such as those shown in FIGS.15 and 16, and to a fully extended position, shown in FIG. 17. As shownin FIGS. 15-17, the shape of the distal portion of the tube 14C directsthe measurement portion 52C at an angle of about 135° from thelongitudinal axis 57 of the straight portion of the tube 14C. Thus, asthe ruler 16C is extended, it is angled to the left and curves backtoward the proximal end of the coordinate instrument. As the ruler 16Cis retracted, it is pulled into the tube channel 38 and flexed to fitwithin the confines of the tube channel 38.

It should be understood that the coordinate instrument 12A is capable ofthe same range of motion as that described above for the coordinateinstrument 12C, although the measurement portion 52C would extendoutward and to the right instead of to the left as shown in FIGS. 14-17.

Referring now to the measuring instruments 12D and 12E, as shown inFIGS. 11-12 and 26-29, the distal portions of these tubes 14D, 14E arecurved away from the straight portions at an angle of about 90°. In themeasuring instrument 12D of FIG. 11, the distal portion of the tube iscurved to the right while in the measuring instrument 12E of FIG. 12,the distal portion of the tube is curved to the left. The distal ends ofthese rulers 16D, 16E include hooks 56D, 56E like those illustrated inFIGS. 4A and 4B and described above with respect to measuring instrument12B.

The range of movement of the measuring instrument 12E is illustrated inFIGS. 26-29. FIG. 26 shows the measuring instrument 12E with theactuator shaft 40E fully retracted, thereby retracting the measurementportion 52E fully into the channel 38 of the tube 14E. The ruler 16E mayalso be retracted until the hook 56E at the distal end 22E is pulledfully into the channel 38 of the tube 14E. The actuator knob or handle42E may also be pushed or slid in the distal direction (or held steadywhile the handle assembly 26E is moved in the proximal direction) toextend the ruler to intermediate positions, such as those shown in FIGS.27 and 28, and to a fully extended position, shown in FIG. 29.

If a ruler with a straight measurement portion was used with the tube14A, 14C with the angled distal portions instead of a ruler with acurved portion, the movement of the measurement portion would be likethat shown in the alternative embodiment 12F of FIGS. 22-25. It shouldbe understood that an instrument set 10 may also include instrumentslike that shown in FIGS. 22-25, as well as those where the distal end ofthe tube angles to the right instead of to the left.

As shown in FIGS. 12 and 27-29, the shape of the distal portion of thetube 14E directs the measurement portion 52E at an angle of about 90°from the longitudinal axis 57 of the straight portion of the tube 14E.Thus, as the ruler 16E is extended, it is angled to the left of themeasuring instrument. As the ruler 16E is retracted, it is pulled intothe tube channel 38 and flexed to fit within the confines of the tubechannel 38.

It should be understood that the measuring instrument 12D is capable ofthe same range of motion as that described above for the measuringinstrument 12E, although the measurement portion 52D would extendoutward and to the right instead of to the left as shown in FIGS. 27-29.

All of the above-described designs for the tubes 14A, 14B, 14C, 14D,14E, 14F, actuators 40A, 40B, 40C, 40D, 40E, 40F and rulers 16A, 16B,16C, 16D, 16E, 16F can be used with the alternative handle assembly 126illustrated in FIGS. 37-38. In FIGS. 37-40 and in the followingdescription of the alternative handle assembly, reference numbers areused without letter designations to indicate that the handle assemblycan be used with any of the tubes 14A-14F, rulers 16A-16F and actuators40A-40F illustrated or described herein.

As shown in FIGS. 37-38, the handle assembly 126 includes a base 164, ahandle post 166, two screws 168, 170, a thumb gear assembly 172, a spurgear 174 and two ball plungers 176. The base 164 has a distallongitudinal channel 178 (shown in FIG. 38) and two transverse bores incommunication with the distal longitudinal channel. The distallongitudinal channel 178 receives a shoulder 134 that has two dimples.The shoulder 134 receives the distal end 18 of a tube 16; the tube andshoulder are connected in any suitable manner, such as by welding. Theassembly of the tube 16 and shoulder 134 is held in place at the distalend of the base 164 by the two ball plungers 176, which engage thedimples in the shoulder 134.

The distal longitudinal channel 178 communicates with a longitudinaldistal bore 180, which communicates with a central open area 182 in thebase 164, which communicates with a longitudinal female threaded opening184. The female threaded opening 184 receives a distal male threadedportion 186 (see FIG. 38) of the post 166. The post 166 includes alongitudinal channel 188 that communicates with the central open area182 and extends to the proximal end 190 of the post 166. The distallongitudinal channel 178 and longitudinal distal bore 180 of the base164 and longitudinal channel 188 of the post 166 are co-axial with thechannel 38 of the tube 14.

The ruler 16 extends through the channel 38 of the tube 14, through thedistal channel 136 of the shoulder 134, through the reduced diameterproximal channel 138 of the shoulder 134, through the longitudinaldistal bore 180 of the base 164, through the central open area 182 ofthe base 164 and through the longitudinal channel 188 of the post 166.In the central open area 182 of the base 164, the ruler 16 passesbetween part of the thumb gear assembly 172 and the spur gear 174.

As shown in FIGS. 39 and 40, the thumb gear assembly 172 is mounted tothe base 164 by the screw 168 and the spur gear 174 is mounted to thebase 164 by the screw 170. The thumb gear assembly 172 is freelyrotatable on the smooth shaft of the screw 168 and the spur gear 174 isfreely rotatable on the smooth shaft of the screw 170.

The thumb screw assembly 172 comprises a thumb wheel 190 and a thumbgear 192 mounted coaxially on the screw 168. The outer surface of thethumb wheel 190 has a plurality of axial splines so that the surgeon caneasily rotate the wheel 190 with a thumb or finger. The thumb wheel 190receives a reduced diameter portion of the thumb gear 192 so that thethumb wheel 190 and thumb gear 192 rotate together.

The thumb gear 192 has a plurality of grooved teeth 194 that intermeshwith the grooved teeth 196 of the spur gear 174. As shown in FIG. 40,the intermeshing grooved teeth 194 of the thumb gear 192 and groovedteeth 196 of the spur gear 174 define a passageway 198 that isco-axially aligned with the distal longitudinal channel 178 andlongitudinal distal bore 180 of the base 164 and longitudinal channel188 of the post 166. A portion of the ruler 16 extends between the thumbgear 192 and the spur gear 174, passing through the passageway 198defined by the grooved teeth 194, 196. Where the proximal surface of oneof the thumb gear teeth 194 meets and engages the distal surface of oneof the spur gear teeth 196, at least one of the transverse dimensions ofthe passageway 198 is slightly less than the outer diameter of the ruler16 so that the intermeshing teeth 194, 196 grip the ruler 16. Thus, theruler 16 can be reciprocated in the proximal-distal direction byrotating the thumb wheel 190, and the surgeon can extend and retract themeasurement portion 52 of the ruler 16 with the same hand used to graspthe handle post 166. As shown in FIG. 38, the proximal end 24 of theruler 16 is connected to the shaft 40 within the longitudinal channel188 of the post 166. Shaft 40 includes distance indicia 48 as in theprior embodiments, and extension of the measurement portion 52 of theruler 16 causes a corresponding retraction of the shaft 40 through anopening in the post 166 of the handle assembly 126 into the longitudinalchannel 188 of the post 166.

To allow the rulers 16A, 16B, 16C, 16D, 16E, 16F to be retracted andextended through the illustrated ranges of motions, the rulers may bemade of a shape-memory material or of a super-elastic material. Theruler material should be one that can be shaped into a pre-determinedshape (such as straight, angled or curved or a combination of straight,angled or curved segments), marked with distance indicia, havesufficient rigidity to retain its pre-determined shape when extendedover a distance such as 10-50 mm, that can deform to fit within theshape of the channel 38 of the tube 14 when retracted, that can bedirected in a particular direction by the shape of the channel whenextended, and that will regain its pre-determined shape when extendedbeyond the channel. Finally, the material should be one that is suitablefor surgical use. An example of a suitable material is nitinol(nickel-titanium alloy). It is anticipated that other alloys and othermaterials such as polymers and composites will also be usable as a shapememory or super-elastic material for the rulers. Accordingly, thepresent invention should not be limited to any particular materialunless expressly called for in the claims.

The rulers 16A, 16B, 16C, 16D, 16E, 16F can be preformed into thedesired shape, such as the curved shape of rulers 16A, 16C or thestraight shape of rulers 16B, 16D, 16E, 16F. The hooks 56 can bepre-formed in at the distal ends of the rulers 16B, 16C, 16D, 16E, 16F(and the distal ends rounded or otherwise made blunt) and distalsegments can be bent and sharpened to form the sharp anchoring tips 58A,58C of the coordinate rulers 16A, 16C.

All of the other components of the surgical coordinate and measuringinstruments 12A, 12B, 12C, 12D, 12E, 12F can be made of standardmaterials for surgical instruments. For example, the main body 28A, 28B,28C, 28D, 28E, 28F, front piece 30A, 30B, 30C, 30D, 30E, 30F and ferrule32A of the handle assembly 26A, 26B, 26C, 26D, 26E, 26F can be made ofacetyl co-polymer, as can the actuator handle 42A, 42B, 42C, 42D, 42E,42F. The actuator shaft 40A, 40B, 40C, 40D, 40E, 40F can be made of 304stainless steel bar. All of the components of the handle assembly 126 ofFIGS. 37-38 can also be made of standard materials for surgicalinstruments. For example, the base 164 and post 166 can be made ofacetyl co-polymer, and the gears 174, 192, thumb wheel 190, screws 168,170 and ball plungers 176 can be made of stainless steel. It should beunderstood that all of these materials are identified as examples only;the present invention is not limited to any particular material unlessexpressly called for in the claims.

Use of the illustrated instruments is described below and illustrated inFIGS. 30-33 in treating a defect in the meniscus, shown at 70 in FIGS.30-33. In the illustrations, the tissue defect 72 comprises a gap in theposterior portion of the medial horn 74 of the meniscus 70 created by apartial meniscectomy. Although not described in detail below, it shouldbe understood that the technique described below can also be used intreating tissue defects in other areas of the medial horn 74 of themeniscus as well as in the lateral horn 76 of the meniscus. It shouldalso be understood that the technique described below can also beapplied in treating defects at other tissue sites in a patient's body.In FIGS. 30-33, a portion of the anterior cruciate ligament is shown at78 and a portion of the posterior cruciate ligament is shown at 80.

The surgeon can perform standard arthroscopic procedures to createportals to gain access to the medial horn 74 of the meniscus. Standardcannulae can be inserted through the portals, and a standard arthroscope(not shown) can be used for visualization of the tissue site. Theappropriate coordinate instrument (12C for example) is selected and themeasurement portion 52C of the coordinate ruler 16C is fully retractedinto the channel 38 of the tube 14C (as shown in FIG. 14). The tube 14Cmay then be inserted through one of the cannulae and guided to themedial meniscus 74. When the distal end 18C of the tube 14C is inposition at the medial meniscus 74, the surgeon can fix the anchor 58Cat a pre-selected anatomical site by pressing the sharp pointed end 60of the anchor 58C into the tissue. In FIGS. 30-31, the anchor 58C isfixed in the posterior horn of the medial meniscus 74 at its juncturewith the posterior cruciate ligament 80, midway between the anterior andposterior edge of the meniscus. This fixation point, designated 82 inFIGS. 30 and 31, then serves as a first benchmark for mapping thelocation of the defect 72. In FIGS. 32-33, the anchor 58C is fixed inthe anterior portion of the posterior horn of the medial meniscus 74 atits juncture with the posterior cruciate ligament 80; this alternatefixation point is designated 83 in FIGS. 32-33.

With the anchor 58C secured to the meniscus, the surgeon can then gentlypull the handle assembly 26C in the proximal direction with one handwhile holding onto the actuator handle 42C with the other hand. As thesurgeon does so, the measurement portion 52C of the coordinate ruler 16Cis extended out of the channel 38 of the tube 14C and the proximalportion 44C of the actuator shaft 40C is drawn into the channel 38 atthe proximal end of the tube 14C. The surgeon may stop pulling when thedistal end 18C of the tube 14C reaches an anatomical feature or defectfeature, such as the first edge of the defect 72, and note the distancefrom the fixation point 82 or 83 by observing the distance indicia 48Con the proximal portion 44C of the actuator shaft 40C or by observingthe distance indicia 54C on the measurement portion 52C of the ruler 16Cthrough the arthroscope. The surgeon may then continue pulling thehandle assembly 26C until the distal end 18C of the tube 14C reachesanother anatomical feature or defect feature, such as the opposite edgeof the defect 72, and note the distance from the fixation point 82 or 83by observing the distance indicia 48C on the proximal portion 44C of theactuator shaft 40C or by observing the distance indicia 54C on themeasurement portion 52C of the ruler 16C through the arthroscope. Thus,the surgeon can map two edges of the defect 72 with respect to a fixedreference 82 or 83 and concurrently measure the distance between twoedges of the defect 72.

Although the surgeon may choose to use the coordinate instruments 12A,12C for all distance measurements, the surgeon may advantageously usethe measuring instruments 12B, 12D, 12E, 12F in combination with thecoordinate instrument 12A or 12C to continue mapping the location of thedefect. In addition, the surgeon could use one or more of the measuringinstruments 12B, 12D, 12E, 12F without using one of the coordinateinstruments 12A, 12C if desired.

Depending on the surgeon's desired approach, one of the measuringinstruments 12B, 12D, 12E, 12F may be selected. In FIGS. 31 and 33, themeasuring instrument 12B with the straight tube 14B is illustrated beingused. Further mapping with the measuring instrument 12B may be done withthe coordinate instrument 12C fixed in place so that measurements can betaken with reference to the fixed distance indicia 54C of the coordinateinstrument 12C. These fixed distance indicia 54C may serve as additionalbenchmarks, or may be used to define a baseline, for furthermeasurements for mapping.

The measurement portion 52B of the ruler 16B is fully retracted into thechannel 38 of the tube 14B (as shown in FIG. 18). The tube 14B may thenbe inserted through one of the cannulae and guided to the medialmeniscus 74. When the distal end 18B of the tube 14C is in position atthe medial meniscus 74, the surgeon can place the hook 56 at the distalend 22B of the measurement portion 52B of the ruler 16B along themeasurement portion 52C of the coordinate ruler 16C as shown in FIG. 31,or at an anatomical feature, such as the posterior surface of the defect72 as shown in FIG. 33. The surgeon may then gently pull the handleassembly 26B in the proximal direction with one hand while holding ontothe actuator handle 42B with the other hand. As the surgeon does so, themeasurement portion 52B of the ruler 16B is extended out of the channel38 of the tube 14B and the proximal portion 44B of the actuator shaft40B is drawn into the channel 38 at the proximal end of the tube 14B. Asshown in FIG. 31, the surgeon may stop pulling when the distal end 18Bof the tube 14B reaches an anatomical feature or defect feature (such asthe interior edge of the defect 72; alternatively, as shown in FIG. 33,the surgeon may stop pulling when the distal end 18B of the tube 14Breaches a selected indicia on the coordinate ruler 52C serving as abenchmark. Since the length of the exposed measurement portion 52B ofthe ruler 16B corresponds with the length of the actuator shaft 40Bdrawn into the tube 14B, the surgeon may note the distance indicia shownat the juncture of the exposed actuator shaft 40B and the proximal endof the handle assembly 26B (see, for example, FIG. 36); the distanceindicia shown at this juncture (shown at 49 in FIG. 36) corresponds withthe distance between a selected distance indicia on the coordinate ruler16C and the hook 56 (and thereby the distance to the anatomical ordefect feature on or against which the hook rests). Alternatively, thesurgeon can observe the distance indicia 54B on the measurement portion52B of the ruler 16B through the arthroscope. The surgeon may thencontinue this process to map the location of selected portions of thedefect 72 with respect to the location of selected points along themeasurement portion 54C of the coordinate ruler 16C Essentially, thesurgeon can map the defect with respect to benchmarks provided byselected distance indicia (or a baseline defined by the selecteddistance indicia) on the measurement portion 54C of the coordinate ruler16C. If desired, the surgeon can also measure the position of severalpoints along the measurement portion 54C of the coordinate ruler 16Cwith respect to fixed anatomical reference positions to ensure thatplacement of the measurement portion 54C of the coordinate ruler 16C isconsistent in future uses of the instrument set.

Measurements can also be taken using one of the intra-articularmeasuring instruments 12B, 12D, 12E, 12F without using theintra-articular coordinate instrument 12A or 12C. FIGS. 34 and 35illustrate use of measuring instrument 12B, but it should be understoodthat the following method may be used with any of the intra-articularmeasuring instruments 12B, 12D, 12E, 12F. As described above, themeasurement portion 52B of the ruler 16B is first fully retracted intothe channel 38 of the tube 14B (as shown in FIG. 18). The tube 14B isthen inserted through one of the cannulae and guided to the desiredsite, such as the medial meniscus 74. When the distal end 18B of thetube 14C is in position in the joint space, the surgeon may place thehook 56 at the distal end 22B of the measurement portion 52B of theruler 16B to an anatomical or defect feature: in FIG. 34, the hook 56 isillustrated placed along the posterior edge of the meniscus, with thehook 56 facing down (distally); in FIG. 35, the hook is illustratedplaced against the posterior surface of the defect 72, with the hook 56facing upward (proximally). The surgeon may then gently pull the handleassembly in the proximal direction with one hand while holding onto theactuator handle 42B with the other hand. As the surgeon does so, themeasurement portion 52B of the ruler 16B is extended out of the channel38 of the tube 14B and the proximal portion 44B of the actuator shaft40B is retracted into the channel 38 at the proximal end of the tube14B. The surgeon may stop pulling when the distal end 18B of the tube14B reaches another anatomical or defect feature, such as the top edgeof the defect 72 as illustrated in FIG. 34 or the interior edge of thedefect 72 as illustrated in FIG. 35, for example. The surgeon may thennote the distance by observing the distance indicia 54B on themeasurement portion 52B of the ruler 16B through the arthroscope;alternatively, since the length of the measurement portion 52B of theruler 16B exposed beyond the distal end 18B of the tube 14B correspondswith the length of the actuator 40B withdrawn into the handle assembly26B, the surgeon can also observe the distance indicia 49 on theactuator shaft 40B, as illustrated in FIG. 36. The surgeon can repeatthese steps at additional locations to complete the measurement of thedefect 72 or other anatomical feature.

If the handle assembly 126 of FIGS. 37-38 is used, the surgeon can movethe coordinate rulers 16A, 16C and measurement rulers 16B, 16D, 16E, 16Fthroughout their ranges of motion with the same hand used to hold thehandle assembly 126, simply by rotating the thumb wheel 190. Thus, thesurgeon will have a free hand for performing other tasks if desired.

The surgeon can use the measurements taken with the instrument set 10 todetermine the appropriate size of implant to be used in treating thedefect 72 and can then deliver the appropriate implant to the site andfix the implant in place. An example of an implant that may be used inrepairing a meniscal defect is disclosed in U.S. patent application Ser.No. 10/747349 entitled “Implantable Tissue Repair Device and Method,”filed on Dec. 29, 2003 by Jenks, Malaviya, Schwartz, Whalen and Zannis,which is incorporated by reference herein in its entirety. The implantmay include a cover and a wedge as disclosed therein, and the cover mayextend beyond the sides or edges of the wedge to provide fixation areasthat may be used to suture or otherwise fix the implant to native tissueor bone, with the wedge generally filling the gap in the native meniscaltissue left after a partial meniscectomy. It is anticipated thatsurgeons will trim the fixation areas of the implant intra-operativelyto suit the needs of the individual patient. The therapeutic implant,method of making the implant, and method of repairing cartilage usingthe implant may include the teachings of the following United StatesPatent Applications, the complete disclosures of which are incorporatedby reference herein: Ser. No. 10/172,347 entitled “HybridBiologic-Synthetic Bioabsorbable Scaffolds” (U.S. Patent Publication No.20030023316A1); Ser. No. 10/195,334 entitled “Cartilage Repair andRegeneration Scaffolds and Method” (U.S. Patent Publication No.20030033021A1); Ser. No. 10/195,341 entitled “Hybrid Biologic/SyntheticPorous Extracellular Matrix Scaffolds” (U.S. Patent Publication No.20030021827A1); Ser. No. 10/195,344 entitled “Unitary Surgical Deviceand Method” (U.S. Patent Publication No. 20030078617A1); Ser. No.10/195,354 entitled “Porous Extracellular Matrix Scaffold and Method”(U.S. Patent Publication No. 20030044444A1); Ser. No. 10/195,606entitled “Cartilage Repair and Regeneration Device and Method” (U.S.Patent Publication No. 20030033022A1); Ser. No. 10/195,633 entitled“Porous Delivery Scaffold and Method” (U.S. Patent Publication No.2003-0049299A1; Attorney Docket No. 265280-71207, DEP-762); Ser. No.10/195,719 entitled “Devices from Naturally Occurring BiologicallyDerived Materials” (U.S. Patent Publication No. 20030032961A1); and Ser.No. 10/195,794 entitled “Meniscus Regeneration Device and Method” (U.S.Patent Publication No. 20030036797A1; Attorney Docket No. 265280-71141,DEP-745). It should be understood that the particular implants, featuresof the implants, methods of making the implants and methods of repairingcartilage are provided as examples only; the present invention is notlimited to the illustrated implants or to meniscal implants or to anyparticular method of making or using implants unless expressly calledfor in the claims.

To confirm that an appropriate size of implant is selected, thetemplates disclosed in the United States Provisional Patent Applicationentitled “Implant System and Method With Sizing Templates,” filedconcurrently herewith by Anthony Zannis, Danny E. McAdams, Brian A.Magee, Herbert E. Schwartz and Andrew M. Jacobs (and which isincorporated by reference herein in its entirety) may be used. Todeliver the implant arthroscopically, devices may be used like thosedisclosed in the following United States Patent Applications, which areincorporated by reference herein in their entireties: U.S. patentapplication Ser. No. 10/610,287 entitled “Slide and Kit for DeliveringImplants” (filed Jun. 30, 2003) and U.S. Provisional Patent ApplicationSer. No. 60/483,804 entitled “Instrument for Delivery of Implant” (filedJun. 30, 2003). However, the present invention is not limited to anyparticular implant, surgical technique or surgical instrument unlessexpressly set forth in the claims.

To evaluate the effectiveness of the treatment, the surgeon can repeatthe steps outlined above at different intervals during the healingprocess. For example, at six months following implantation, the surgeoncan once again create arthroscopic portals and insert cannulae to gainaccess to the tissue site. The appropriate intra-articular coordinateinstrument 12A, 12C is selected and introduced as described above. Thepointed anchor tip 58C is fixed at the same anatomical reference 82 asin the initial surgery and the measurement portion 52C is extended asdescribed above. A measuring instrument 12B, 12D, 12E, 12F with a hook56 at the distal end of the ruler 16B, 16D, 16E, 16F can then also beintroduced to the tissue site as discussed above. The surgeon can thenuse the instruments to locate the positions of the original defectlandmarks and evaluate the clinical results achieved through thetreatment.

Although the technique of the present invention has been described abovewith respect to an arthroscopic procedure, it should be understood thatthe instruments and technique of the present invention can also be usedwith more invasive surgical procedures, such as a mini-arthrotomy or anopen surgical procedure.

While only specific embodiments of the invention have been described andshown, it is apparent that various alternatives and modifications can bemade thereto. Those skilled in the art will also recognize that certainadditions can be made to the illustrative embodiments. It is, therefore,the intention in the appended claims to cover all such alternatives,modifications and additions as may fall within the true scope of theinvention.

1. A surgical instrument having a proximal end and a distal end, thesurgical instrument comprising a tube and a ruler, the tube having aproximal end, a distal end, and an elongate channel; the ruler having aproximal end, a distal end, a straight portion received within thechannel of the tube, a measurement portion between the straight portionand the distal end, and an anchoring tip at the distal end, themeasurement portion of the ruler including distance indicia and theanchoring tip having a pointed end; wherein the measurement portion ofthe ruler lies in a plane; wherein the pointed end of the anchoring tipis spaced from the plane of the measurement portion of the ruler; andwherein the ruler is reciprocable in a proximal-distal direction withrespect to the tube between a retracted position and an extendedposition.
 2. The surgical instrument of claim 1 wherein in the retractedposition at least part of the measurement portion of the ruler isreceived within the channel of the tube and in the extended position atleast part of the measurement portion of the ruler is exposed outside ofthe channel of the tube.
 3. The surgical instrument of claim 1 whereinthe anchoring tip of the ruler comprises a segment of the ruler having alongitudinal axis that intersects the plane of the measurement portionof the ruler.
 4. The surgical instrument of claim 3 wherein thelongitudinal axis of the anchoring tip is perpendicular to the plane ofthe measurement portion of the ruler.
 5. The surgical instrument ofclaim 1 wherein at least part of the measurement portion of the ruler iscurved when the ruler is in the extended position.
 6. The surgicalinstrument of claim 1 wherein at least part of the ruler comprises ashape-memory material.
 7. The surgical instrument of claim 6 wherein atleast part of the ruler comprises nitinol.
 8. The surgical instrument ofclaim 1 wherein at least part of the ruler comprises a super-elasticmaterial.
 9. The surgical instrument of claim 8 wherein thesuper-elastic material comprises nitinol.
 10. The surgical instrument ofclaim 1 further comprising a handle having a proximal end and a distalend, the distal end of the handle being connected to the proximal end ofthe tube, the handle further having a channel aligned with the channelof the tube.
 11. The surgical instrument of claim 10 further comprisingan actuator shaft having a proximal end and a distal end, the distal endof the actuator shaft being connected to the proximal end of the ruler,at least part of the actuator shaft being received in the channel of thehandle, the actuator shaft being reciprocable in a proximal-distaldirection with respect to the channel of the handle.
 12. The surgicalinstrument of claim 11 wherein the proximal end of the actuator shaft isexposed beyond the proximal end of the handle when the ruler is in theretracted position and when the ruler is in the extended position. 13.The surgical instrument of claim 12 wherein a portion of the actuatorshaft includes distance indicia that are exposed beyond the proximal endof the handle when the ruler is in the retracted position and when theruler is in the extended position.
 14. The surgical instrument of claim1 wherein the distal end of the tube has a maximum cross-sectional outerdimension of 12 mm or less.
 15. The surgical instrument of claim 1wherein the tube has a proximal portion having a longitudinal axis and adistal portion having a longitudinal axis intersecting the longitudinalaxis of the proximal portion.
 16. A surgical instrument having aproximal end and a distal end, the surgical instrument comprising a tubeand a ruler, the tube having a proximal end, a distal end, and anelongate channel; the ruler having a proximal end, a distal end, astraight portion received within the channel of the tube, a measurementportion between the straight portion and the distal end and a hook atthe distal end, the measurement portion of the ruler including distanceindicia; wherein the ruler is reciprocable in a proximal-distaldirection with respect to the tube between a retracted position and anextended position.
 17. The surgical instrument of claim 16 wherein inthe retracted position at least part of the measurement portion of theruler is received within the channel of the tube and in the extendedposition at least part of the measurement portion of the ruler isexposed outside of the channel of the tube.
 18. The surgical instrumentof claim 16 wherein at least part of the ruler comprises a shape-memorymaterial.
 19. The surgical instrument of claim 18 wherein at least partof the ruler comprises nitinol.
 20. The surgical instrument of claim 16wherein at least part of the ruler comprises a super-elastic material.21. The surgical instrument of claim 20 wherein the super-elasticmaterial comprises nitinol.
 22. The surgical instrument of claim 16further comprising a handle having a proximal end and a distal end, thedistal end of the handle being connected to the proximal end of thetube, the handle further having a channel aligned with the channel ofthe tube.
 23. The surgical instrument of claim 22 further comprising anactuator shaft having a proximal end and a distal end, the distal end ofthe actuator shaft being connected to the proximal end of the ruler, atleast part of the actuator shaft being received in the channel of thehandle, the actuator shaft being reciprocable in a proximal-distaldirection with respect to the channel of the handle.
 24. The surgicalinstrument of claim 23 wherein the proximal end of the actuator shaft isexposed beyond the proximal end of the handle when the ruler is in theretracted position and when the ruler is in the extended position. 25.The surgical instrument of claim 24 wherein a portion of the actuatorshaft includes distance indicia that are exposed beyond the proximal endof the handle when the ruler is in the retracted position and when theruler is in the extended position.
 26. The surgical instrument of claim16 wherein the distal end of the tube has a maximum cross-sectionalouter dimension of 12 mm or less.
 27. The surgical instrument of claim16 wherein the tube has a proximal portion having a longitudinal axisand a distal portion having a longitudinal axis intersecting thelongitudinal axis of the proximal portion.
 28. The surgical instrumentof claim 16 wherein the ruler is straight between the hook and theproximal end of the ruler and the tube is straight along its length. 29.The surgical instrument of claim 16 wherein the tube includes an angleddistal portion and a straight portion.
 30. The surgical instrument ofclaim 16 wherein the tube includes a curved portion and a straightportion.
 31. A surgical instrument set comprising first and secondsurgical instruments, each surgical instrument having a proximal end anda distal end, and each surgical instrument comprising a tube and aruler, the tube of each surgical instrument having a proximal end, adistal end and a channel extending from the proximal to the distal end;the ruler of each surgical instrument having a proximal end, a distalend, a measurement portion between the proximal end and the distal endand a straight portion between the measurement portion and the proximalend, the measurement portion including distance indicia; wherein thestraight portion of the ruler of each surgical instrument has alongitudinal axis; wherein the ruler of each surgical instrument isreciprocable in a proximal-distal direction with respect to the tubebetween a retracted position and an extended position; and wherein thedistal end of the ruler of the first surgical instrument comprises ananchoring tip having a pointed end and the distal end of the ruler ofthe second surgical instrument comprises a hook.
 32. The surgicalinstrument set of claim 31 wherein in the retracted position at leastpart of the measurement portion of the ruler of each instrument isreceived within the channel of the tube and in the extended position atleast part of the measurement portion of the ruler of each instrument isexposed outside of the channel of the tube.
 33. The surgical instrumentset of claim 31 wherein the measurement portion of the ruler of eachinstrument lies in a plane and wherein the pointed end of the anchoringtip of the first instrument is spaced from the plane of the measurementportion of the ruler of that instrument.
 34. The surgical instrument setof claim 33 wherein the anchoring tip comprises a segment of the rulerhaving a longitudinal axis that intersects the plane of the measurementportion of the ruler of the first surgical instrument.
 35. The surgicalinstrument set of claim 34 wherein the longitudinal axis of theanchoring tip is perpendicular to the plane of the measurement portionof the ruler of the first surgical instrument.
 36. The surgicalinstrument set of claim 31 wherein at least part of the measurementportion of the ruler of the second surgical instrument is angled in onedirection with respect to the longitudinal axis of the straight portionof the ruler of the second surgical instrument when the ruler of thesecond instrument is in the extended position.
 37. The surgicalinstrument set of claim 36 wherein at least part of the measurementportion of the ruler of the second surgical instrument is perpendicularto the longitudinal axis of the straight portion of the ruler of thatinstrument when the ruler is in the extended position.
 38. The surgicalinstrument set of claim 36 wherein a least part of the measurementportion of the ruler of the second surgical instrument defines an acuteangle with the longitudinal axis of the straight portion of the ruler ofthe second surgical instrument when the ruler of the second surgicalinstrument is in the extended position.
 39. The surgical instrument setof claim 31 wherein at least part of the measurement portion of theruler of the first surgical instrument is curved.
 40. The surgicalinstrument set of claim 31 wherein at least part of the ruler of eachsurgical instrument comprises a shape-memory material.
 41. The surgicalinstrument set of claim 40 wherein at least part of the ruler of eachsurgical instrument comprises nitinol.
 42. The surgical instrument setof claim 31 wherein at least part of the ruler of each surgicalinstrument comprises a super-elastic material.
 43. The surgicalinstrument set of claim 42 wherein the super-elastic material of eachsurgical instrument comprises nitinol.
 44. The surgical instrument setof claim 31 wherein each surgical instrument includes a handle having aproximal end and a distal end, the distal end of the handle beingconnected to the proximal end of the tube of that instrument, the handlefurther having a channel aligned with the channel of the tube of thatinstrument.
 45. The surgical instrument set of claim 44 wherein eachinstrument includes an actuator shaft having a proximal end and a distalend, the distal end of the actuator shaft being connected to theproximal end of the ruler of that instrument, at least part of theactuator shaft being received in the channel of the handle of thatinstrument, the actuator shaft being reciprocable in a proximal-distaldirection in the channel of the handle of that instrument.
 46. Thesurgical instrument set of claim 45 wherein the proximal end of theactuator shaft of each instrument is exposed beyond the proximal end ofthe handle of that instrument when the ruler of that instrument is inthe retracted position and when the ruler of that instrument is in theextended position.
 47. The surgical instrument set of claim 46 wherein aportion of the actuator shaft of each instrument includes distanceindicia that are exposed beyond the proximal end of the handle of thatinstrument when the ruler of that instrument is in the retractedposition and when the ruler of that instrument is in the extendedposition.
 48. The surgical instrument set of claim 31 wherein the distalend of the tube of each instrument has a maximum cross-sectional outerdimension of 12 mm or less.
 49. The surgical instrument set of claim 31wherein the tube of the second surgical instrument is straight along itsentire length.
 50. The surgical instrument set of claim 31 wherein thetube of the second surgical instrument has a proximal portion having alongitudinal axis and a distal portion having a longitudinal axisintersecting the longitudinal axis of the proximal portion.
 51. Thesurgical instrument set of claim 31 wherein the measurement portion ofthe ruler of the first surgical instrument has one shape when the rulerof that instrument is in the extended position and the measurementportion of the ruler of the second surgical instrument has a differentshape when the ruler of that instrument is in the extended position. 52.The surgical instrument set of claim 31 wherein in the retractedposition at least part of the measurement portion of the ruler of eachinstrument is received within the channel of the tube and in theextended position at least part of the measurement portion of the rulerof each instrument is exposed outside of the channel of the tube.
 53. Asurgical instrument set comprising a plurality of surgical instruments,each surgical instrument having a proximal end and a distal end, andeach surgical instrument comprising a tube and a ruler, the tube of eachsurgical instrument having a proximal end, a distal end and a channelextending from the proximal to the distal end; the ruler of eachsurgical instrument having a proximal end, a distal end, a measurementportion between the proximal end and the distal end and a straightportion between the measurement portion and the proximal end, themeasurement portion including distance indicia; wherein the straightportion of the ruler of each surgical instrument has a longitudinalaxis; wherein the ruler of each surgical instrument is reciprocable in aproximal-distal direction with respect to the tube between a retractedposition and an extended position; and wherein the measurement portionof the ruler of each surgical instrument extends in a differentdirection from the longitudinal axis of the straight portion when theruler is in the extended position.
 54. The surgical instrument set ofclaim 53 wherein in the retracted position at least part of themeasurement portion of the ruler of each instrument is received withinthe channel of the tube and in the extended position at least part ofthe measurement portion of the ruler of each instrument is exposedoutside of the channel of the tube.
 55. The surgical instrument set ofclaim 53 wherein the distal end of the ruler of one instrument includesan anchoring tip having a pointed end.
 56. The surgical instrument setof claim 53 wherein the measurement portion of the ruler of eachinstrument lies in a plane and wherein the pointed end of the anchoringtip is spaced from the plane of the measurement portion of the ruler ofthat instrument.
 57. The surgical instrument set of claim 56 wherein theanchoring tip comprises a segment of the ruler having a longitudinalaxis that intersects the plane of the measurement portion of that ruler.58. The surgical instrument set of claim 57 wherein the longitudinalaxis of the anchoring tip is perpendicular to the plane of themeasurement portion of the ruler.
 59. The surgical instrument set ofclaim 53 wherein at least part of the measurement portion of the rulerof one instrument is angled in one direction with respect to thelongitudinal axis of the straight portion of the ruler of thatinstrument and at least part of the measurement portion of the ruler ofanother instrument is angled in another direction with respect to thestraight portion of the ruler of that instrument when the rulers are inthe extended position.
 60. The surgical instrument set of claim 59wherein at least part of the measurement portion of the ruler of atleast one instrument is perpendicular to the longitudinal axis of thestraight portion of the ruler of that instrument when the ruler is inthe extended position.
 61. The surgical instrument set of claim 59wherein at least part of the measurement portion of the ruler of atleast one instrument defines an acute angle with the longitudinal axisof the straight portion of the ruler of that instrument when the ruleris in the extended position.
 62. The surgical instrument set of claim 53wherein at least part of the measurement portion of the ruler of oneinstrument is curved in one direction and at least part of themeasurement portion of the ruler of another instrument is curved in anopposite direction.
 63. The surgical instrument set of claim 53 whereinat least part of the ruler of each instrument comprises a shape-memorymaterial.
 64. The surgical instrument set of claim 63 wherein at leastpart of the ruler of each instrument comprises nitinol.
 65. The surgicalinstrument set of claim 53 wherein at least part of the ruler of eachinstrument comprises a super-elastic material.
 66. The surgicalinstrument set of claim 65 wherein the super-elastic material of eachinstrument comprises nitinol.
 67. The surgical instrument set of claim53 wherein each instrument includes a handle having a proximal end and adistal end, the distal end of the handle being connected to the proximalend of the tube of that instrument, the handle further having a channelaligned with the channel of the tube of that instrument.
 68. Thesurgical instrument set of claim 67 wherein each instrument includes anactuator shaft having a proximal end and a distal end, the distal end ofthe actuator shaft being connected to the proximal end of the ruler ofthat instrument, at least part of the actuator shaft being received inthe channel of the handle of that instrument, the actuator shaft beingreciprocable in a proximal-distal direction in the channel of the handleof that instrument.
 69. The surgical instrument set of claim 68 whereinthe proximal end of the actuator shaft of each instrument is exposedbeyond the proximal end of the handle of that instrument when the rulerof that instrument is in the retracted position and when the ruler ofthat instrument is in the extended position.
 70. The surgical instrumentset of claim 69 wherein a portion of the actuator shaft of eachinstrument includes distance indicia that are exposed beyond theproximal end of the handle of that instrument when the ruler of thatinstrument is in the retracted position and when the ruler of thatinstrument is in the extended position.
 71. The surgical instrument setof claim 53 wherein the distal end of the tube of each instrument has amaximum cross-sectional outer dimension of 12 mm or less.
 72. Thesurgical instrument set of claim 53 wherein the tube of at least oneinstrument is straight along its entire length.
 73. The surgicalinstrument set of claim 53 wherein a portion of the tube of oneinstrument is curved in one direction and a portion of the tube ofanother instrument is curved in an opposite direction.
 74. The surgicalinstrument set of claim 53 wherein the tube of at least one instrumenthas a proximal portion having a longitudinal axis and a distal portionhaving a longitudinal axis intersecting the longitudinal axis of theproximal portion.
 75. The surgical instrument set of claim 53 whereinthe measurement portion of the ruler of one instrument has one shapewhen the ruler of that instrument is in the extended position and themeasurement portion of the ruler of another instrument has a differentshape when the ruler of that instrument is in the extended position. 76.A method of mapping a feature of a tissue site of a patient with asurgical instrument, the surgical instrument including a tube and aruler reciprocable with respect to the tube between a retracted positionand an extended position, the ruler including a distal end and distanceindicia, the method comprising: moving a portion of the tube to thetissue site with at least part of the ruler retracted; piercing thetissue with a portion of the ruler at a selected fixation point totemporarily anchor the distal end of the ruler to the tissue at thefixation point; moving the tube with respect to the ruler so that theruler is in the extended position; determining a distance based on theposition of the tissue feature with respect to the fixation site; andmoving the tube with respect to the ruler so that the ruler is in theretracted position and removing the tube and ruler from the tissue site.77. The method of claim 76 wherein distance is determined by viewingdistance indicia outside of the arthroscopic portal.
 78. The method ofclaim 76 further comprising the steps of: providing a second surgicalinstrument including a tube and a ruler reciprocable with respect to thetube between a retracted position and an extended position, the rulerincluding a distal end and distance indicia; moving a portion of thetube of the second instrument to the tissue site with at least part ofthe ruler retracted; fixing an end of the ruler to the tissue at asecond location spaced from the fixation point; moving the tube of thesecond instrument with respect to the ruler so that the ruler is in theextended position and wherein a portion of the ruler of the secondinstrument crosses a portion of the ruler of the first instrument;determining a distance based on the position of the ruler of the secondinstrument with respect to the ruler of the first instrument; and movingthe tube with respect to the ruler so that the ruler is in the retractedposition and removing the tube and ruler from the tissue site.
 79. Themethod of claim 76 further comprising moving a portion of the tube tothe same tissue site in the same patient at a later time, guiding thetube to the same tissue site with at least part of the ruler in theretracted position, moving the ruler to the extended position, piercingthe tissue at a selected location to temporarily anchor the distal endof the ruler to the fixation point; determining a location based on theposition of part of the ruler with respect to the fixation point andmoving the ruler to the retracted position and removing the tube andruler from the tissue site.
 80. The method of claim 79 wherein thefixation point is substantially the same in both procedures.
 81. Themethod of claim 76 wherein the tissue site is the meniscus.
 82. A methodof measuring a feature of a tissue site within the body of a patientwith a surgical instrument, the surgical instrument including a tubehaving a proximal end and a distal end, an elongated member reciprocablewith respect to the tube between a distally retracted position and adistally extended position, the elongated member having a proximal endand a distal end, and distance indicia at the proximal end of theelongated member, the method comprising: moving the distal end of thetube to the tissue site within the body of the patient; positioning thedistal end of the elongated member at a first desired location; movingthe tube with respect to the elongated member so that the distal end ofthe tube is at a second desired location while the position of thedistal end of the elongated member is maintained at the first desiredlocation; determining the distance between the first desired locationand the second desired location by observing the distance indicia at theproximal end of the elongated member.
 83. The method of claim 82 whereinthe elongated member comprises an assembly of a ruler at the distal endand a shaft at the proximal end.
 84. The method of claim 82 wherein theproximal end of the elongated member is maintained outside of thepatient's body throughout the procedure.
 85. The method of claim 82wherein the tissue site is the meniscus of the knee.
 86. A method ofmapping a feature of a tissue site of a patient with a surgicalcoordinate instrument and a surgical measuring instrument, the surgicalcoordinate instrument including a tube and a coordinate rulerreciprocable with respect to the tube between a retracted position andan extended position, the coordinate ruler including a distal end anddistance indicia, the surgical measuring instrument including a tube anda ruler reciprocable with respect to the tube between a retractedposition and an extended position, the ruler including a distal end anddistance indicia, the method comprising: moving a portion of the tube ofthe coordinate instrument to the tissue site with at least part of thecoordinate ruler retracted, piercing the tissue with a portion of thecoordinate ruler at a selected fixation point to temporarily anchor thedistal end of the coordinate ruler to the tissue at the fixation point,moving the tube with respect to the coordinate ruler so that thecoordinate ruler is in the extended position; moving a portion of thetube of the measuring instrument to the tissue site with at least partof the ruler retracted, placing the distal end of the ruler at a desiredlocation related to the feature to be mapped, moving the tube withrespect to the ruler until a portion of the measuring instrument crossesthe coordinate ruler; determining the distance between a portion of thesurgical measuring instrument and the coordinate ruler.
 87. The methodof claim 86 wherein the step of determining the distance between aportion of the surgical measuring instrument and the coordinate rulercomprises determining the distance between the hook and a location onthe coordinate ruler.
 88. The method of claim 86 wherein the feature tobe mapped comprises a defect and wherein the desired location forplacement of the distal end of the ruler of the measuring instrumentcomprises a portion of the defect.
 89. A surgical instrument having aproximal end and a distal end, the instrument comprising: a handle atthe proximal end; a tube extending distally from the handle, the tubedefining a channel; a first gear rotatably mounted to the handle, thefirst gear having a plurality of grooved teeth; a second gear rotatablymounted to the handle, the second gear having a plurality of groovedteeth intermeshed with the grooved teeth of the first gear, the groovesof the intermeshed teeth of the first gear and second gear defining apassageway aligned with the channel of the tube; and an elongated memberextending through the passageway and into the channel of the tube, theelongated member being movable in a proximal direction by rotating thefirst gear in one direction and being movable in the distal direction byrotating the first gear in the opposite direction; wherein the elongatedmember has a distal end and includes distance indicia at the distal end.90. The surgical instrument of claim 89 wherein the elongated member hasa proximal end and includes distance indicia at the proximal end. 91.The surgical instrument of claim 90 wherein the proximal end of theelongated member extends out the proximal end of the handle.
 92. Thesurgical instrument of claim 91 wherein the elongated member comprisesan assembly of a ruler and a shaft.